Current Status of Sentinel Lymph Node Mapping and Biopsy: Facts and Controversies

Abstract

Lymphatic mapping and sentinel lymph node biopsy were first reported in 1977 by Cabanas for penile cancer. Since that time, the technique has become rapidly assimilated into clinical practice. Morton first described the application of lymphatic mapping for melanoma only a decade ago, and this technique is now accepted as the standard of care. The application for lymphatic mapping and sentinel lymph node biopsy in breast cancer remains approximately 5 years behind its utilization in melanoma.This technique has the potential to be utilized in all solid tumors. The rapid assent of this technique in clinical practice is the result of multiple factors, including accuracy, decreased morbidity, and supplying the pathologist with only a few nodes to allow a more focused and sensitive pathologic evaluation. Despite the success and acceptance of lymphatic mapping, many controversies remain. We have attempted to clearly highlight these controversies in this review.

Photodynamic detection of diseased axillary sentinel lymph node after oral application of aminolevulinic acid in patients with breast cancer

“…The driving forces behind this rapid acceptance are mainly a result of the accuracy of the procedure with a significant decrease in morbidity over the old standard of care, a level I and II node dissection (Jakub et al, 2003). It is of increasing interest to quickly detect the sentinel lymph node and to know whether there it is metastasised in order to decide whether axillary lymph node dissection becomes necessary.…”

The use of FDG-PET in assessing axillary lymph node status in breast cancer: a systematic review and meta-analysis of the literature

“…This technique has resulted in a significant reduction in morbidity compared with axillary lymph node dissection (ALND) and clearance [4]. It is unsuccessful in 3-6% of patients and has a false negative rate of 2.1-2.7% when compared to axillary node dissection and clearance [5,6]. The nature of SNB means that it has no false positives and consequently no patient is erroneously upstaged in terms of their tumour.…”

Intraoperative Sentinel Lymph Node Mapping of the Lung Using Near-Infrared Fluorescent Quantum Dots

“…The underlying hypothesis of SLN mapping is that the first lymph node to receive lymphatic drainage from a tumor site will contain tumor cells if there has been direct lymphatic spread [5]. Current techniques with regard to the identification of the SLN involve radioguided lymphatic mapping and/or visualization of the nodes with vital blue dyes [6].…”